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FORM 3
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person(1)
Richvalsky Steven J.
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(Last) (First) (Middle)
4335 Varsity Drive, Suite E
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(Street)
Ann Arbor MI 48108
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
May 4, 2000
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Genomic Solutions Inc., Nasdaq National Market System (GNSL)
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5. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [_] 10% Owner
[x] Officer (give title below) [_] Other (specify below)
Executive Vice President, Chief Financial Officer, Secretary and Treasurer
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6. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form Filed by One Reporting Person
[_] Form Filed by More Than One Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
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3. Ownership Form:
2. Amount of Securities Direct (D) or
1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership
(Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4)
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<S> <C> <C> <C>
Callable Common Stock 36,553(1) D
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(1) This number includes 1,860 shares of callable common stock that will be
issued upon the automatic exercise of warrants at the closing of the Company's
initial public offering.
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FORM 3 (CONTINUED)
TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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<TABLE>
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5. Owner-
3. Title and Amount of Securities ship
Underlying Derivative Securities Form of
2. Date Exercisable (Instr. 4) Derivative
and Expiration Date --------------------------------- 4. Conver- Security:
(Month/Day/Year) Amount sion or Direct 6. Nature of
---------------------- or Exercise (D) or Indirect
Date Expira- Number Price of Indirect Beneficial
1. Title of Derivative Exer- tion of Derivative (I) Ownership
Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C> <C> <C> <C> <C>
Options (1) 1/15/08 Callable 45,000 $.37 D
Common Stock
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Options (2) 1/15/08 Callable 3,600 $.37 D
Common Stock
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Options (3) 5/1/08 Callable 9,000 $2.00 D
Common Stock
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Options (4) 5/4/10 Callable 25,000 7.20 D
Common Stock
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Explanation of Responses:
(1) These options were granted in January 1998 and will vest upon completion
of the Company's initial public offering.
(2) These options were granted in January 1998 and will vest as follows: 1,200
on 1/15/01; 1,200 on 1/15/02; and 1,200 on 1/15/03.
(3) These options were granted in May 1998. 2,250 of these options already
vested and the remaining 6,750 will vest at completion of the Company's
initial public offering.
(4) These options were granted and will vest upon completion of the Company's
initial public offering.
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/s/ Steven J. Richvalsky 5/4/2000
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Signature of Reporting Person(1) Date
Steven J. Richvalsky
(1)Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
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(Print or Type Responses)
